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Cardiovascular > Hypertension > Flashcards

Hypertension Flashcards

1
Q

describe confirming diagnosis of hypertension

A

ensure;
ambulatory blood pressure monitoring (ABPM) - at least 2 measurements per hour during the person’s usual waking hours (about 14 a day)

home blood pressure monitoring (HBPM);
2 consecutive seated measurements, 1 minute apart
BP is recorded twice a day for a least 4 days and preferably 7 days
measurements on the first day are discarded - average value of all remaining is used

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2
Q

describe white coat effect

A

BP is high in clinical visit, normal at home

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3
Q

describe who is more likely to express white coat syndrome

A 
female
old -main risk in all hypertension
smoker
high clinical systolic BP
variable daytime readings
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4
Q

describe masked hypertension

A

BP normal in clinical visit, high at home

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5
Q

stage 1 hypertension

A

clinic BP is 140/90 mmHg

ABPM or HBPM daytime average is 135/85 mmHg

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6
Q

stage 2 hypertension

A

clinic BP is 160/100 mmHg

ABPM or HBPM daytime average is 150/95 mmHg

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7
Q

severe hypertension

A

clinic BP >180

clinic diastolic BP is >110

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8
Q

assessing cardiovascular risk and taget organ damage

A

estimation of CV risk to discuss prognosis and healthcare options with people with hypertension

for patients with hypertension, offer to;
test urine for presence of protein
take blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholesterol
examine fundi for hypertensive retinopathy
ECG

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9
Q

ASSIGN score

A

assess risk of CVS disease

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10
Q

describe end organ damage

A 
end risk factor of hypertension
can occur in;
left ventricular hypertrophy - abnormal V4 wave on ECG
creatinine raised
albuminuria/microalbuminuria
retinopathy
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11
Q

established vascular disease

A 
ischaemic heart disease
cerbo-vascular disease
peripheral vascular disease
diabetes 
>20% CV risk over 10 years
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12
Q

care pathway for stage 1 hypertension

A

if target organ damage present or 10 year CV risk - offer antihypertensive drug treatment

if younger than 40 - consider specialist referral

for all, then follow;
offer lifestyle interventions
offer patient education and interventions to support adherence to treatment
offer annual review of care to monitor blood pressure, provide support and discuss lifestyle, symptoms and medication

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13
Q

care pathway for stage 2 hypertension

A

offer antihypertensive drug treatment

offer lifestyle interventions
offer patient education and interventions to support adherence to treatment
offer annual review of care to monitor blood pressure, provide support and discuss lifestyle, symptoms and medication

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14
Q

explain the antihypertensive drug treatment - step 1

A
  1. ACE inhibitor
  2. If ACE not tolerated (e.g. cough), offer ARB
  3. Do NOT combine ACE and ARB inhibitors
  4. calcium blocker (CCB) - if patient does not have type 2 diabetes
  5. If CCB not tolerated (e.g. oedema), offer thiazide-like diuretic. If evidence of heart fialure, offer thiazide-like diuretic and follow guidelines on chronic heart failure
  6. If starting or changing diuretic treatment for hypertension, offer a thiazide-like diuretic, such as indapamide in preference to a conventional thiazide diuretic such as bendroflumethiazide or hydrochlorothiazide.
  7. For adults with hypertension already having treatment with bendroflumethiazide or hydrochlorothiazide, who have stable, well-controlled blood pressure, continue with their current treatment.
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15
Q

explain the antihypertensive drug treatment - step 2

A
  1. if hypertension not controlled with ACE or ARB, add CCB or thiazide-like diuretic in addition to treatment
  2. if hypertension not controlled with CCB in step 1, add ACE or ARB or thiazide-like diuretic in addition to treatment
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16
Q

explain the antihypertensive drug treatment - step 3

A
  1. ACE or ARB AND CCB AND thiazide-like diuretic
17
Q

explain the antihypertensive drug treatment - step 4

A

Consider further diuretic therapy with low-dose spironolactone for adults with resistant hypertension starting step 4 treatment who have a blood potassium level of 4.5 mmol/l or less. Use particular caution in people with a reduced estimated glomerular filtration rate because they have an increased risk of hyperkalaemia
When using further diuretic therapy for step 4 treatment of resistant hypertension, monitor blood sodium and potassium and renal function within 1 month of starting treatment and repeat as needed thereafter.
Consider an alpha-blocker or beta-blocker for adults with resistant hypertension starting step 4 treatment who have a blood potassium level of more than 4.5 mmol/l.

18
Q

describe monitoring drug treatment - <80, >80, white coat effect

A

<80 - 140/90 mmHg
>80 - 150/90 mmHg

whitecoat effect;
<80 - 135/85 mmHg
>80- 145/85 mmHg

19
Q

describe causes of secondary hypertension

A 
common;
renal disease
obstructive sleep apnoea
aldosternosim
reno-vascular disease 
uncommon;
cushing's
pheochromocytoma - easy to miss
hyperparathyroidism
aortic coarctation 
intracranial tumour 
fibromuscular dysplasia - corkscrew affect or artery, common in younger woman
20
Q

describe beta blockers in treatment of hypertension

A 
not first line of treatment in primary hypertension 
used more in complicated hypertension;
arrhythmias
coronary artery disease
congestive heart failure 
increased sympathetic activity
21
Q

describe combination therapy

A

starting with 2 drugs always better than starting with one - better control
fewer side affects than mono-therapy

22
Q

describe causes of resistant hypertension

A 
concordance 
white coat effect
pseudo-hypertension 
lifestyle factors 
drug interactions 
secondary hypertension
true resistance
23
Q

describe treatment for resistant hypertension

A

spironolactone is most effective treatment;
start low and build up
not for patients with diabetes

24
Q

describe new technology for treatment of hypertension

A

renal denervation
baro-receptor stimulation
rox coupler

Cardiovascular (39 decks)

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